SkillStat Learning

Please print and fill out this form. Fax or mail the form together with a check (cheque) or credit card details. Address and fax number are included on the bottom of this form. Your order will be processed within one business day after receiving the form. Thank you for choosing SkillStat’s learning tools.

1. Products

Units	Item	Code	Unit Price	Cost
	SkillStat Learning Tools CD-ROM	SST-CD001
	SkillStat Learning Tools Download	SST-S001
	Six Second ECG Workbook (Coil Bind)	SST-P002
	Six Second ECG Workbook CD-ROM	SST-CD002
	Six Second ECG Workbook Download	SST-S002
	Managing Cardiac Emergencies (Coil Bind)	SST-P003
	Managing Cardiac Emergencies CD-ROM	SST-CD003
	Managing Cardiac Emergencies Download	SST-S003
	Learning Tools and Book Bundle (Bound)	SST-P004
	Learning Tools and Book Bundle CD-ROM	SST-CD004
	Learning Tools and Book Bundle Download	SST-S004
	Six Second ECG Instructor Kit (2 binders)	SST-P005
	Six Second ECG Instructor Kit CD-ROM	SST-CD005
	Six Second ECG Instructor Kit Download	SST-S005
	Six Second ECG Presentation Kit	SST-PK005
Sub-Total
Canadian Residents please add 7% GST
Total

2. Billing Information

Name

Company

Address

Suite Number

City

State / Province

Country

Zip / Postal Code

Phone Number

Fax Number

E-Mail Address

3. Shipping Information Same as Billing Info

Name

Company

Address

Suite Number

City

State / Province

Country

Zip / Postal Code

4. Additional Instructions

5. Method of Payment

By Enclosed Check (cheque)

By Credit Card Visa MasterCard American Express

Name on Card

Expiration Date (month/year) Total Charged

Signature

SkillStat Learning Inc. Phone: 1-604-960-0065
3515 Sunset Boulevard Fax: 1-866-347-2019
North Vancouver, British Columbia E-Mail: customer1@skillstat.com
Canada. V7R 3Y1

Note: Information submitted on this form will be used solely for the purpose of this purchase. For further details on SkillStat’s privacy policy, please visit the following web page http://www.skillstat.com/privacy.htm .